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In heading up a coalition David Cameron has had to confront two unusual constraints that prevent him from being a dominant prime minister. The first constraint, something unfamiliar to previous prime ministers, is his having to work with and through a coalition partner firmly placed to the Conservatives’ left. The second constraint, equally problematic but more familiar, is that Cameron has faced a restive Conservative parliamentary party in which a sizable minority of Tory MPs remained unreconciled to his political agenda. These two interrelated constraints mean Cameron has lacked the freedom of manoeuvre enjoyed by most past prime ministers. Two aspects of Cameron’s premiership help cast light on his predicament: first, his relations with Nick Clegg and the Liberal Democrats and second, the nature of his dependency upon Conservative MPs. We look at these in turn and conclude by assessing Cameron’s effectiveness as prime minister.

The power of the party leader, because it is such a moveable feast, is hard to measure, understand or theorise. This article, using Cameron’s leadership of the Conservative party in opposition as a case study, contends that the modern party leader (singular) can play by far the leading role within their party and parliamentary leadership (plural). Opposition party leaders have the potential to be powerful (that is they will be ‘preeminent’) because they (1) lead the ‘shadow government’; (2) have the right of proposal and veto over party policy and electoral strategy; (3) have a powerful private office which is able to lead and direct the party both within and without parliament; and (4) control the party’s ‘official’ news media operation, which can represent the leader’s policy preferences as the party’s policy preferences. But the preeminent leader will be considerably empowered (that is, they will become ‘predominant’) when they possess and make use of four personal power resources (and they will be disempowered if they do not): (1) having a reputation for being ‘leadership material’; (2) being associated with actual or anticipated political success; (3) being electorally popular; and (4) having a high standing in his or her parliamentary party. Under certain contextual circumstances the modern electoral professional, office-seeking UK party leader can be both preeminent and predominant. Even if they lack the entirely free hand to do whatever they want, such a party leader will ‘lead’, not simply ‘follow’ their party. The leadership style of Cameron, building upon that of Thatcher and Blair, was not his singular invention, but rather a reaction to and a trend-setter of far-reaching transformations wrought in the form of the UK political party.

The notion that the British prime minister had outgrown the parliamentary system enabled some scholars to theorise that the prime minister had become more ‘powerful’ over time and allowed critics to lambast Tony Blair for being unnecessarily and unreasonably powerful. Keith Dowding (2012) suggests it is time to ‘finally put an end to the presidentialisation argument’ (p. 2), but the notion— in both its uses—had fallen from favour long before his recent attempt to administer a coup de grâce. For one thing presidentialisation was forever undone by proof Blair was often hamstrung politically by his chancellor, Gordon Brown. By itself this illustrates that Blair, harried by Brown for the entirety of his premiership, was no president, even if at times a very powerful prime minister. No member, say, of any US president’s executive (not even the vice president, the only person who can succeed the president) could ever engineer the president’s ousting in the way Brown and his followers in Labour’s parliamentary party obliged Blair to step aside in June 2007. No US Treasury secretary (nor any other cabinet member) could ever have been as obstructive, insubordinate or disloyal to the president they serve as Brown was to Blair. Presidentialisation fell further from favour when Brown proved a weaker and less effective prime minister. Few suggested Brown was so empowered a prime minister he had become a president. And fewer still, given the realities of coalition government, refer to David Cameron in such fashion when he has presently to share some degree of power—over both the choice of policy and of ministerial personnel—with the deputy prime minister, Nick Clegg (Bennister and Heffernan, 2012).

Forming a coalition involves compromise, so a prime minister heading up a coalition government, even one as predominant a party leader as David Cameron, should not be as powerful as a prime minister leading a single-party government. Cameron has still to work with and through ministers from his own party, but has also to work with and through Liberal Democrat ministers; not least the Liberal Democrat leader Nick Clegg. The relationship between the prime minister and his deputy is unchartered territory for recent academic study of the British prime minister. This article explores how Cameron and Clegg operate within both Whitehall and Westminster: the cabinet arrangements, the prime minister's patronage, advisory resources and more informal mechanisms. Cameron and Clegg both possess institutional and personal resources, but Cameron remains the predominant resource-rich actor, so at this stage in the coalition government we can observe that no formal, substantial change in the role of prime minister has been enacted. Cameron's predominance, by leading a coalition, is partially constrained by Clegg, but he too constrains Clegg. This prime minister, then, can be predominant even when he is constrained in significant ways by the imperatives of coalition government. Cameron is presently no more constrained than a prime minister who is faced with a pre-eminent intra-party rival with a significant power base.

The broad consequences of New Labour were that it won Labour three elections and put the party in government for thirteen years. Its most immediate legacies are twofold: first, the faltering economy and the sovereign debt crisis bequeathed to its successor; second, the electoral, ideational and organisational problems Labour itself has to face. The Blair and Brown governments never radically reformed the Thatcherite economic settlement but were, in time, incrementally to rework the economic policy they inherited. Change amid continuity was present in Labour's use of the proceeds of market-driven economic growth to radically increase investment in the public services and expand the welfare state. New Labour, in the wider political context, partially reformed the institutional environment in which politics is enacted; it played some part in helping the Conservative party educate itself on social questions; and helped alter the form and function of the modern political party. Closer to home, New Labour changed the Labour party forever.

Objectives We describe a field simulation that was conducted using volunteers to assess the ability of 3 hospitals in a network to manage a large influx of patients with a potentially communicable disease. This drill provided the opportunity to evaluate the ability of the New York City Department of Health and Mental Hygiene's (NYC-DOHMH) emergency department chief complaint syndromic surveillance system to detect a cluster of patients with febrile respiratory illness. Methods The evaluation was a prospective simulation. The clinical picture was modeled on severe acute respiratory syndrome symptoms. Forty-four volunteers participated in the drill as mock patients. Results Records from 42 patients (95%) were successfully transmitted to the NYC-DOHMH. The electronic chief complaint for 24 (57%) of these patients indicated febrile or respiratory illness. The drill did not generate a statistical signal in the NYC-DOHMH SaTScan analysis. The 42 drill patients were classified in 8 hierarchical categories based on chief complaints: sepsis (2), cold (3), diarrhea (2), respiratory (20), fever/flu (4), vomit (3), and other (8). The number of respiratory visits, while elevated on the day of the drill, did not appear particularly unusual when compared with the 14-day baseline period used for spatial analyses. Conclusions This drill with a cluster of patients with febrile respiratory illness failed to trigger a signal from the NYC-DOHMH emergency department chief complaint syndromic surveillance system. This highlighted several limitations and challenges to syndromic surveillance monitoring.

The news media interest in political celebrity, backed up by the phenomenon of process journalism, magnifies the modern prime minister, placing him or her centre stage in key political processes. Tony Blair’s communication strategy has had two objectives. First, whenever possible, to try to secure favourable media coverage of the government. Second, to keep the government and its supporters on message while defining what that message is. Prime ministers can significantly influence the news agenda through use of authoritative, self-referential communication. Such influence is not uncontested because senior ministers, opposition politicians and backbench critics also use the news media to promote themselves and their competing agendas. The news media itself will also spin the stories it is spun, create those stories and thereby probe- and sometimes help fashion- intra-governmental differences and prime ministerial challenges. Nonetheless, by dominating government-centric political communications- and therein significantly influencing the news agenda- the prime minister can thereby reinforce his or her ability to agenda set within government. The news media, always an obstacle as well as a resource, a permanent critic as well as an occasional friend, can therefore provide an additional power resource to an already powerful and predominant prime minister.

Institutions cannot be understood without exploring the actors who occupy them, while actors cannot be understood without examining the institutions they inhabit. Ultimately, the actions of both institutions and actors cannot be understood separate to the political, social and economic context within which they are located. Tony Blair, rightly cited as an example of a powerful prime minister, does not have a monopoly of power, but he does have an extensive authority. The prime minister requires two things to operate effectively within Whitehall and Westminster: first, power over their parliamentary majority; and second, power within the government they lead. Because this power is contested and challenged, the age-old question, the actual degree of collegiality within government, is as central to contemporary debates about the working of the core executive as to the ancient debate about prime ministerial versus cabinet government. The prime minister is therefore best modelled as a strong, but sometimes weak, parliamentary chief executive.

Privatisation in the UK was facilitated by the interplay of ideas, institutions, actors, and economic interests. The motivations of the programme were ideational and political, but the objectives were economic and administrative. Together these paved the way for the success of the policy. Although several rationales were at play in the unfolding of privatisation, the ideological predilection of the Thatcher governments underpinned this far-reaching policy reform. This explains why the Thatcher government did not reform nationalized industries within the public sector, but instead shifted them into the private sector. Privatisation succeeded because it was championed by new right policy entrepreneurs, was supported by interest groups prepared to support, or least not impede, such dramatic policy change, and when the public enterprise status quo was deemed in need of reform. Of course, ideas only act as a catalyst for policy change when an established policy agenda having withered, been worn-out or otherwise discredited, can then be successfully challenged.

The notion of presidentialisation, applied to the British Prime Minister, usually focuses more on the personal style of the of the officeholder, less on the institutional substance of the office itself. The Prime Minister is the product of the British parliamentary system, and this system—and the institutional structures it imposes—provides for and circumscribes his or her powers. Comparing Britain with the US demonstrates that in executive-legislative terms a British Prime Minister is more commanding than any US President, while in intra-executive terms the President is more powerful. The presidentialisation notion fails to acknowledge that its legislative purchase makes the British parliamentary executive more authoritative than its US presidential counterpart. Should, as is often but not always the case, a Prime Minister be able to lead his or her executive, determine its key decisions, shape its agenda and guide the work of its ministers, he or she will be a more influential actor than the President. Systemic differences distinguish Prime Ministers from Presidents. Britain does not have a presidential system, so it cannot have a presidential chief executive.

Prime ministerial predominance can enable the prime minister to lead, if not command, the core executive, and, in concert with others, to direct, if not control, its policy development. Leadership predominance facilitates prime ministerial predominance within the executive, and prime ministerial predominance reinforces leadership predominance within the party. Such predominance arises from the prime minister's ability to access a series of personal and institutional power resources. The more resources, the more powerful and predominant the prime minister is; the fewer resources, the less powerful and predominant they are. Such resources are necessarily transient, being accumulated and inevitably dispersed, acquired and lost, and are never permanent. When possessed, they can grant the prime minister considerable, if never overwhelming, intra-executive authority and influence, and the opportunity to be a stronger, but not the only element within the core executive.

After the 2001 World Trade Center disaster, the New York City Department of Health was under heightened alert for bioterrorist attacks in the city. An emergency department (ED) syndromic surveillance system was implemented with the assistance of the Centers for Disease Control and Prevention to ensure early recognition of an increase or clustering of disease syndromes that might represent a disease outbreak, whether natural or intentional. The surveillance system was based on data collected 7 days a week at area EDs. Data collected were translated into syndromes, entered into an electronic database, and analyzed for aberrations in space and time within 24 hours. From September 14-27, personnel were stationed at 15 EDs on a 24-hour basis (first staffing period); from September 29-October 12, due to resource limitations, personnel were stationed at 12 EDs on an 18-hour basis (second staffing period). A standardized form was used to obtain demographic information and classify each patient visit into 12 syndrome categories. Seven of these represented early manifestations of bioterrorist agents. Data transfer and analysis for time and space clustering (alarms) by syndrome and age occurred daily. Retrospective analyses examined syndrome trends, differences in reporting between staffing periods, and the staff's experience during the project. A total of 67,536 reports were received. The system captured 83.9% of patient visits during the first staffing period, and 60.8% during the second staffing period (P0.01). Five syndromes each accounted for more than 1% of visits: trauma, asthma, gastrointestinal illness, upper/lower respiratory infection with fever, and anxiety. Citywide temporal alarms occurred eight times for three of the major bioterrorism-related syndromes. Spatial clustering alarms occurred 16 times by hospital location and 9 times by ZIP code for the same three syndromes. No outbreaks were detected. On-site staffing to facilitate data collection and entry, supported by daily analysis of ED visits, is a feasible short-term approach to syndromic surveillance during high-profile events. The resources required to operate such a system, however, cannot be sustained for the long term. This system was changed to an electronic-based ED syndromic system using triage log data that remains in operation.

Drawing on the Kuhnian model of scientific paradigms, this article suggests consensus politics should be conceptualised not as an agreement or a settlement but as a political framework that derives from an ideationally informed policy paradigm. Such a consensus constrains the autonomy of governing elites, encouraging them to conform to an established policy agenda that defines the ‘mainstream’ wherein ‘the possible is the art of politics’. In Britain, as demonstrated by the replacement of a post-war social democratic paradigm by a contemporary neo-liberal successor, periods of policy continuity and incremental reform have been matched by occasions of dramatic political change. Any appreciation of consensus politics has therefore to explain change as well as account for stability, something considerably under emphasised in the existing literature. Consensus politics are therefore best defined as a constrained space within which politics is conducted and political actors differ, a paradigmatic framework from which political outcomes emerge, and never as an agreement freely entered into. Looking at consensus politics beyond the much commented upon post-war example, this article uses British politics since 1945 as an exemplar of consensus politics and an illustration of how a consensus can be forged, how it can endure and how it may change.

Looking for one specific point of origin of the far reaching transformation of the Labour Party obscures rather than illuminates the complex process which lies behind its ideological self-redefinition. This response to Adam Lent's article in Politics Volume 17, ‘Labour's Transformation: Searching for the Point of Origin’, argues that the long march from the party of Michael Foot to that led by Tony Blair is more usefully explored in terms of a gradual, staged process This transformation, evidenced in alterations in Labour's programmatic stance, electoral strategy and stated political objectives, was enacted in the period 1983–1997 as a whole. While several significant ‘moments of transition’ can be identified none are by themselves a single ‘point of origin’.

Wide geographic variation in the prevalence of drug-resistant Streptococcus pneumoniae demonstrates the importance of tracking antimicrobial resistance locally. This survey of hospital microbiology laboratories in New York City found that penicillin resistance (MIC > or = 2.0 micrograms/ml) increased from 1.5% of S. pneumoniae isolates in 1993 to 6.3% in 1995 and that in 1995, one-third of isolates nonsusceptible to penicillin (MIC > or = 0.1 microgram/ml) were also nonsusceptible to an extended-spectrum cephalosporin (MIC > or = 1 microgram/ml).

Purpose: The purpose of this study was to describe human immunodeficiency virus (HIV)-associated risk behaviors among adolescents attending a clinic for the treatment of sexually transmitted disease in New York City. Methods: A total of 4,585 volunteers were interviewed and HIV-tested, including 456 adolescents (aged 13–19 years), of whom 220 were women (48%) and 236 men (52%). Results: Fewer than 1% of the 456 adolescents said they injected drugs. Unprotected vaginal sex was the most common sexual behavior, with 93% of adolescents reporting "always" having vaginal sex, and 57% "rarely or never" using condoms. Anal sex was reported by 18%. Twenty percent of adolescent men had paid for sex, compared to just 1% of women, whereas 3% of men and 4% of women had traded sex for money or drugs. Nine women and three men tested HIV seropositive. All three HIV-positive men reported having had receptive anal sex with men. Among women, HIV seropositivity was most strongly associated with crack cocaine use and trading sex for money or drugs. Conclusions: HIV prevalence was high, with most infections owing to sexual transmission rather than intravenous drugs. The increased risk of HIV infection in adolescent women was associated with high-risk sex related to crack use and the exchange of sex for money or drugs.

Elite centred, its target audience decision‐makers in Whitehall and Westminister, the Adam Smith Institute is as much a political actor as it is a genuine think tank. It has no wish to study the wo...

Party leaders (plural, not singular) collectively dominate their party, so the party leader as prime minister, when they are sufficiently personally resourced to make full use of their prime ministerial institutional resources, should be predominant within both party and government. Being predominant, which makes the prime minister a ‘stronger or main element’ within government, provides them with considerable, never overwhelming influence. All party leaders are preeminent, but only some predominant. David Cameron, building on his performance in opposition, has established his predominance within his party, but to what extent is he predominant as prime minister? What restrictions can coalition government impose on his use of his prime ministerial power resources?

About the book: Tony Blair has dominated British political life for more than a decade. Like Margaret Thatcher before him, he has changed the terms of political debate and provoked as much condemnation as admiration. At the end of his era in power, this book presents a wide-ranging overview of the achievements and failures of the Blair governments. Bringing together Britain's most eminent academics and commentators on British politics and society, it examines the effect of the Prime Minister and his administration on the machinery of government, economic and social policy and foreign relations. Combining serious scholarship with clarity and accessibility, this book represents the authoritative verdict on the impact of the Blair years on British politics and society.

Background The importance of understanding age when estimating the impact of influenza on hospitalizations and deaths has been well described, yet existing surveillance systems have not made adequate use of age-specific data. Monitoring influenza-related morbidity using electronic health data may provide timely and detailed insight into the age-specific course, impact and epidemiology of seasonal drift and reassortment epidemic viruses. The purpose of this study was to evaluate the use of emergency department (ED) chief complaint data for measuring influenza-attributable morbidity by age and by predominant circulating virus. Methods and Findings We analyzed electronically reported ED fever and respiratory chief complaint and viral surveillance data in New York City (NYC) during the 2001–2002 through 2005–2006 influenza seasons, and inferred dominant circulating viruses from national surveillance reports. We estimated influenza-attributable impact as observed visits in excess of a model-predicted baseline during influenza periods, and epidemic timing by threshold and cross correlation. We found excess fever and respiratory ED visits occurred predominantly among school-aged children (8.5 excess ED visits per 1,000 children aged 5–17 y) with little or no impact on adults during the early-2002 B/Victoria-lineage epidemic; increased fever and respiratory ED visits among children younger than 5 y during respiratory syncytial virus-predominant periods preceding epidemic influenza; and excess ED visits across all ages during the 2003–2004 (9.2 excess visits per 1,000 population) and 2004–2005 (5.2 excess visits per 1,000 population) A/H3N2 Fujian-lineage epidemics, with the relative impact shifted within and between seasons from younger to older ages. During each influenza epidemic period in the study, ED visits were increased among school-aged children, and each epidemic peaked among school-aged children before other impacted age groups. Conclusions Influenza-related morbidity in NYC was highly age- and strain-specific. The impact of reemerging B/Victoria-lineage influenza was focused primarily on school-aged children born since the virus was last widespread in the US, while epidemic A/Fujian-lineage influenza affected all age groups, consistent with a novel antigenic variant. The correspondence between predominant circulating viruses and excess ED visits, hospitalizations, and deaths shows that excess fever and respiratory ED visits provide a reliable surrogate measure of incident influenza-attributable morbidity. The highly age-specific impact of influenza by subtype and strain suggests that greater age detail be incorporated into ongoing surveillance. Influenza morbidity surveillance using electronic data currently available in many jurisdictions can provide timely and representative information about the age-specific epidemiology of circulating influenza viruses., Don Olson and colleagues report that influenza-related morbidity in NYC from 2001 to 2006 was highly age- and strain-specific and conclude that surveillance using electronic data can provide timely and representative information about the epidemiology of circulating influenza viruses., Editors' Summary Background. Seasonal outbreaks (epidemics) of influenza (a viral infection of the nose, throat, and airways) send millions of people to their beds every winter. Most recover quickly, but flu epidemics often disrupt daily life and can cause many deaths. Seasonal epidemics occur because influenza viruses continually make small changes to the viral proteins (antigens) that the human immune system recognizes. Consequently, an immune response that combats influenza one year may provide partial or no protection the following year. Occasionally, an influenza virus with large antigenic changes emerges that triggers an influenza pandemic, or global epidemic. To help prepare for both seasonal epidemics and pandemics, public-health officials monitor influenza-related illness and death, investigate unusual outbreaks of respiratory diseases, and characterize circulating strains of the influenza virus. While traditional influenza-related illness surveillance systems rely on relatively slow voluntary clinician reporting of cases with influenza-like illness symptoms, some jurisdictions have also started to use “syndromic” surveillance systems. These use electronic health-related data rather than clinical impression to track illness in the community. For example, increased visits to emergency departments for fever or respiratory (breathing) problems can provide an early warning of an influenza outbreak. Why Was This Study Done? Rapid illness surveillance systems have been shown to detect flu outbreaks earlier than is possible through monitoring deaths from pneumonia or influenza. Increases in visits to emergency departments by children for fever or respiratory problems can provide an even earlier indicator. Researchers have not previously examined in detail how fever and respiratory problems by age group correlate with the predominant circulating respiratory viruses. Knowing details like this would help public-health officials detect and respond to influenza epidemics and pandemics. In this study, the researchers have used data collected between 2001 and 2006 in New York City emergency departments to investigate these aspects of syndromic surveillance for influenza. What Did the Researchers Do and Find? The researchers analyzed emergency department visits categorized broadly into a fever and respiratory syndrome (which provides an estimate of the total visits attributable to influenza) or more narrowly into an influenza-like illness syndrome (which specifically indicates fever with cough and/or sore throat) with laboratory-confirmed influenza surveillance data. They found that emergency department visits were highest during peak influenza periods, and that the affect on different age groups varied depending on the predominant circulating viruses. In early 2002, an epidemic reemergence of B/Victoria-lineage influenza viruses caused increased visits among school-aged children, while adult visits did not increase. By contrast, during the 2003–2004 season, when the predominant virus was an A/H3N2 Fujian-lineage influenza virus, excess visits occurred in all age groups, though the relative increase was greatest and earliest among school-aged children. During periods of documented respiratory syncytial virus (RSV) circulation, increases in fever and respiratory emergency department visits occurred in children under five years of age regardless of influenza circulation. Finally, the researchers found that excess visits to emergency departments for fever and respiratory symptoms preceded deaths from pneumonia or influenza by about two weeks. What Do These Findings Mean? These findings indicate that excess emergency department visits for fever and respiratory symptoms can provide a reliable and timely surrogate measure of illness due to influenza. They also provide new insights into how different influenza viruses affect people of different ages and how the timing and progression of each influenza season differs. These results, based on data collected over only five years in one city, might not be generalizable to other settings or years, warn the researchers. However, the present results strongly suggest that the routine monitoring of influenza might be improved by using electronic health-related data, such as emergency department visit data, and by examining it specifically by age group. Furthermore, by showing that school-aged children can be the first people to be affected by seasonal influenza, these results highlight the important role this age group plays in community-wide transmission of influenza, an observation that could influence the implementation of public-health strategies such as vaccination that aim to protect communities during influenza epidemics and pandemics. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040247. • US Centers for Disease Control and Prevention provides information on influenza for patients and health professionals and on influenza surveillance in the US (in English, Spanish, and several other languages) • World Health Organization has a fact sheet on influenza and on global surveillance for influenza (in English, Spanish, French, Russian, Arabic, and Chinese) • The MedlinePlus encyclopedia contains a page on flu (in English and Spanish) • US National Institute of Allergy and Infectious Diseases has a feature called “focus on flu” • A detailed report from the US Centers for Disease Control and Prevention titled “Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks” includes a simple description of syndromic surveillance • The International Society for Disease Surveillance has a collaborative syndromic surveillance public wiki • The Anthropology of the Contemporary Research Collaboratory includes working papers and discussions by cultural anthropologists studying modern vital systems security and syndromic surveillance

BackgroundSchool absenteeism data may have utility as an early indicator of disease outbreaks, however their value should be critically examined. This paper describes an evaluation of the utility of school absenteeism data for early outbreak detection in New York City (NYC).MethodsTo assess citywide temporal trends in absenteeism, we downloaded three years (2001–02, 2002–03, 2003–04) of daily school attendance data from the NYC Department of Education (DOE) website. We applied the CuSum method to identify aberrations in the adjusted daily percent absent. A spatial scan statistic was used to assess geographic clustering in absenteeism for the 2001–02 academic year.ResultsModerate increases in absenteeism were observed among children during peak influenza season. Spatial analysis detected 790 significant clusters of absenteeism among elementary school children (p < 0.01), two of which occurred during a previously reported outbreak.ConclusionMonitoring school absenteeism may be moderately useful for detecting large citywide epidemics, however, school-level data were noisy and we were unable to demonstrate any practical value in using cluster analysis to detect localized outbreaks. Based on these results, we will not implement prospective monitoring of school absenteeism data, but are evaluating the utility of more specific school-based data for outbreak detection.

Reviews a wide range of evidence to demonstrate three things. First, election campaigns have become more candidate-centered, with parties offering leaders greater prominence in their election campaigns and the media devoting greater attention to them. This development seems to have taken place since 1960, which coincides with the spread of mass access to television in Britain, and the erosion of class politics. Second, today’s major-party leaders are in significant ways more strongly placed to exert intra-party power than they were in 1980, much as we might expect of electoral-professional organizations. Third, and perhaps most important, it seems likely that the potential for prime ministerial power within the state’s political executive has been enhanced because of structural changes that have generated a larger and more integrated ‘executive office’ under his or her control since 1970. Of course, these developments have occurred in the context of a highly partified form of parliamentarism. Thus, it is not contended simply that Prime Ministers have become completely indistinguishable from Presidents, but rather, that a number of changes have occurred that are mutually consistent with the working logic of presidentialism.

New York City's first syndromic surveillance systems were established in 1995 to detect outbreaks of waterborne illness. In 1998, daily monitoring of ambulance dispatch calls for influenza-like illness began. After the 2001 World Trade Center attacks, concern about biologic terrorism led to the development of surveillance systems to track chief complaints of patients reporting to emergency departments, over-the-counter and prescription pharmacy sales, and worker absenteeism. These systems have proved useful for detecting substantial citywide increases in common viral illnesses (e.g., influenza, norovirus, and rotavirus). However, the systems have not detected more contained outbreaks earlier than traditional surveillance. Future plans include monitoring school health and outpatient clinic visits, augmenting laboratory testing to confirm syndromic signals, and conducting evaluation studies to identify which of these systems will be continued for the long term.

Background The ability to detect disease outbreaks early is important in order to minimize morbidity and mortality through timely implementation of disease prevention and control measures. Many national, state, and local health departments are launching disease surveillance systems with daily analyses of hospital emergency department visits, ambulance dispatch calls, or pharmacy sales for which population-at-risk information is unavailable or irrelevant. Methods and Findings We propose a prospective space–time permutation scan statistic for the early detection of disease outbreaks that uses only case numbers, with no need for population-at-risk data. It makes minimal assumptions about the time, geographical location, or size of the outbreak, and it adjusts for natural purely spatial and purely temporal variation. The new method was evaluated using daily analyses of hospital emergency department visits in New York City. Four of the five strongest signals were likely local precursors to citywide outbreaks due to rotavirus, norovirus, and influenza. The number of false signals was at most modest. Conclusion If such results hold up over longer study times and in other locations, the space–time permutation scan statistic will be an important tool for local and national health departments that are setting up early disease detection surveillance systems., A new, flexible method for disease outbreak surveillance and its application to emergency department data from New York City

The New York City Department of Health and Mental Hygiene has established a syndromic surveillance system that monitors emergency department visits to detect disease outbreaks early. Routinely collected chief complaint information is transmitted electronically to the health department daily and analyzed for temporal and spatial aberrations. Respiratory, fever, diarrhea, and vomiting are the key syndromes analyzed. Statistically significant aberrations or "signals" are investigated to determine their public health importance. In the first year of operation (November 15, 2001, to November 14, 2002), 2.5 million visits were reported from 39 participating emergency departments, covering an estimated 75% of annual visits. Most signals for the respiratory and fever syndromes (64% and 95%, respectively) occurred during periods of peak influenza A and B activity. Eighty-three percent of the signals for diarrhea and 88% of the signals for vomiting occurred during periods of suspected norovirus and rotavirus transmission.

The impact of Thatcherism has been profound. While the electoral hegemony sought by the Conservative Party was temporary (if not illusory), the Thatcher and Major governments did preside over a dramatic shift in public policy, one clearly evidenced in the shift toward marketisation in the reform of public services; the adoption of new public management techniques; the pursuit of privatisation and deregulation; the reduction of direct taxation; and the establishment of a more centralised system of governments. The Thatcher and Major governments skilfully married political, economic and ideological objectives, a skill which so dramatically deserted the Major-led Conservatives in their public fall from grace after September 1992. None the less, this was an illustration of its willingness to pursue a coherent series of projects against the backdrop of the many political and administrative obstacles it found in its path. Foremost among such projects was the eagerness of key ministers to advance the neo-liberal agenda with which Thatcherism became so associated.

Between 1977 and 1997 the Labour Party offers a textbook example of party change, a process whereby the party altered its appeal and abandoned previously held positions in favour of a new and reformed programme. Given the ‘fundamental assumption … that parties enter government to influence policy making and to control policy implementation’,1 the question is: what endogenous and exogenous factors determine or otherwise influence the policy agenda that parties follow? What determines the attitudes of parties? How does such party change manifest itself? More particularly, how does party change come about?

As is often quoted, toward the end of the 1979 election campaign, the then Labour Prime Minister, Jim Callaghan, all but resigned to impending defeat, remarked to his then adviser Bernard Donoughue: ‘You know there are times, perhaps once every thirty years, there is a sea change in politics. It then does not matter what you say or do. There is a shift in what the public wants and what it approves of. I suspect there is now such a sea change – and it is for Mrs Thatcher.’1 This much over-used and therefore somewhat well-worn quotation effectively makes a point: the advent of Thatcherite politics after 1979 did see a political sea-change, one heralded before 1979 as well as after. As a dominant force in British politics Thatcherism did make a significant contribution to changes in the ideological assumptions that inform policy choice.2

There is something of a vacuum at the heart of a theory of consensus when it is not related to political change. Malcolm Smith rightly suggests that of itself consensus as a concept may not demonstrate how it ‘is arrived at, the mechanism by which general agreement [his definition] is reached, or how general agreement changes over time, how resistant or alternative stances are incorporated into a new, replacement general agreement’.1 Writing of the efforts of Conservative ministers to block certain Labour initiatives in social policy reform after 1942, Paul Addison suggests that they were ‘acting, nevertheless, in a field of force, created by Labour’.2 Conservatives drew up plans for social reform that were ‘closer to Labour ideals than they were to the ideals of Neville Chamberlain’.3 The result of the return of the Conservatives to office after 1951 saw the collectivist advance of the 1940s stemmed but not reversed, and while the Churchill government may have gone some way to meeting the pledge to ‘set the people free’ by restoring some authority to market liberalism at the expense of collectivist planning, the Tory party stood on the right of the post-war political middle ground. Then, as now, political and ideological constraints determined what ministers as political actors could do.

Thatcherism is best explored in terms of its causes, chronology and, ultimately, its consequences. The first steps in the evaluation of the Thatcherite project are: What was it and what did it seek to do? In assessing the impact that it has had, its achievements (matched against those it set itself) must be measured. Andrew Gamble argues that Thatcherism can be variously defined as ‘a set of intellectual doctrines, as a popular political movement, as a style of leadership, as a bloc of interests and as a programme of policy’.1 His view (which has set the yardstick against which all discussions of this issue follow) is that Thatcherism had three overriding objectives: ‘To restore the political fortunes of the Conservative Party, to revive market liberalism as the dominant public philosophy and to create the conditions for a free economy by limiting the scope of the state while restoring its authority to act.’2 Its project was to centre the free market at the heart of economic activity.

A theory of consensus politics should embrace notions of stability, continuity and, most particularly, a concept of change. It can offer an insight into governing across election cycles and the alternation of parties in office. It can demonstrate how policy development is a product of ‘agreement on procedures and broad policy goals with contained disagreements about methods and means’1 and, in the transition from one consensus to another, provoke an appreciation of shifts in political opinion across time. It may also promote an understanding of both policy and political change as an alteration in governing political agendas informed by dominant political ideas. The idea of consensus in political historiography usually ‘describes the overlap between the economic, foreign and social policies of both Labour and Conservative governments’2 throughout the post-war period until its breakdown in the 1970s.

Thatcherism has so permeated the political life of the nation that the influence of its value-based political ideas enacted as policy has had considerable impact on political and not just electoral developments. Yet no permanent coalition of voters endorsed the Thatcherite project and evidence points to the fact that at the level of the electorate the fabled ‘Great Moving Right Show’ was largely illusory: there was ‘no Thatcherite electorate, no Thatcherite party’.1 Despite the electoral success enjoyed by the Conservatives, persuasive claims are made that Thatcherism did not fundamentally alter the nation’s political values. Clearly, certain social democratic values retained strong support among the public even at the height of the Thatcherite boom (as evidenced in opinion research on such matters as collective provision, welfare, and social responsibility).

Since 1975 the reform agenda in British politics has been dominated by the politics of market liberalism. Policy has been recast in as close a neoliberal guise as has proved politically possible and/or administratively practicable. As a result, government is no longer expected to radically reform economic relations. Limited moves toward egalitarianism have been abandoned and moderate attempts to redistribute income and wealth (in cash or in kind) are no longer considered to be acceptable objectives. Both Labour and the Conservatives rule out high rates of progressive taxation and support policy instruments such as marketisation, deregulation, neo-classical economics, lower borrowing and (when possible) less public spending, reform of the welfare state to encourage individual self-reliance and reduce dependency, and the introduction of new public management techniques. The privatisation of state-owned industries and utilities demonstrates the withdrawal of the state from direct control over a great deal of economic activity.

At the 1997 general election, Labour returned from the political wilderness. Its electoral landslide gifting it a Commons majority of 179, the largest in the party’s history on 44.4 per cent of votes cast. None the less, with key exceptions involving the constitutional reform, Europe and supply-side modernisation, the agenda of the incoming Labour government reflects policies pursued by the Thatcher and Major governments. Political values preached by Conservative ministers – enterprise, self reliance, anti-statism – find contemporary reflection in the speeches of Labour ministers. The liberalisation of the market economy; the privatisation of nationalised industries, utilities and public sector companies; the divestment of public housing; the introduction of market liberalism to both the public sector and the non-market public sector; the binding of trade unions; the erosion of local government all collectively represented the wide-ranging redefinition of British political life engineered in the 1980s and 1990s and so serve to structure what Labour in government does.

Europe – or, more particularly, Britain’s place within Europe – has bedevilled all British parties in the last third of Labour’s first century, provoking sharp divisions, particularly in the case of Labour and the Conservatives. While eschewing a narrow, insular little-Englander opposition to things European, the Labour Party was clearly Euro-sceptic between the 1950s and the mid-1980s, although a great many vocal pro-Europeans always numbered among its ranks. When in government in 1967, Labour did apply to join the then EEC, but the party also opposed entry in 1962 and 1970-73 and declared in favour of withdrawal in 1983.

In an age when electors derive the majority of their political information from the news media, political parties are obliged to utilize television and the press to communicate with them. Parties have been using forms of mass communication to advance their partisan cause for the whole of the twentieth century. Political communications, the messages constructed through the mediated interaction of parties, mass media and electors are nothing new. Political campaigning is fought out in the news media because press and broadcast reportage are an integral part of elective politics. Parties attempt to turn this fact to their advantage by successfully projecting themselves through the media to the electorate-as-audience. This is now a significant feature of the political landscape, a widespread and increasingly sophisticated element not just of the modern professional election campaign but of daily political activity.

OBJECTIVES. This study compares characteristics, behaviors, and human immunodeficiency virus (HIV) infection in women who reported same-sex contact and women who had sex only with men. METHODS. Participants were patients attending a New York City sexually transmitted disease clinic. Structured questionnaires were administered by interviewers. RESULTS. Overall, 9% (135/1518) of women reported same-sex contact; among these, 93% also reported contact with men. Women reporting same-sex contact were more likely than exclusively heterosexual women to be HIV seropositive (17% vs 11%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.6), to exchange sex for money/drugs (48% vs 12%, OR = 6.7, 95% CI = 4.6, 9.8), to inject drugs (31% vs 7%, OR = 6.3, 95% CI = 4.1, 9.5), and to use crack cocaine (37% vs 15%, OR = 3.3, 95% CI = 2.2, 4.8). HIV in women reporting same-sex contact was associated with history of syphilis (OR = 8.8), sex for crack (OR = 5.7), and injection drug use (OR = 4.5). CONCLUSIONS. In this study, women who reported same-sex contact were predominantly bisexual. They had more HIV risk behaviors and were more often HIV seropositive than women who had sex only with men. Among these bisexual women, heterosexual contact and injection drug use were the most likely sources of HIV. There was no evidence of female-to-female transmission.